Angel Qin, MD, clinical assistant professor, University of Michigan Health, medical oncologist, Rogel Cancer Center, Michigan Medicine, discusses treatment considerations for immunotherapy in patients with newly diagnosed non–small cell lung cancer.

To make therapeutic decisions, it is necessary to know the staging of the patient, according to Qin. Brain imaging must also be done due to the high propensity for brain metastases, Qin says. Understanding a patient’s molecular testing and PD-1 expression status is needed to inform clinical decisions with immunotherapy, Qin explains. Currently, there are 9 alterations for which FDA-approved targeted therapies are available, and more are under exploration in ongoing trials, Qin explains. 

Furthermore, it is important to understand a patient’s individual goal for treatment, such as whether they want to use a more aggressive approach or focus more on quality of life, Qin adds. It is possible to have both, but because of differing toxicity profiles, 1 therapeutic regimen may prove to be more favorable based on patient preferences, Qin adds. Finally, understanding a patient’s performance status is important and sometimes overlooked. Clinical trials often enroll patients with excellent performance status, and this is not always reflective of the patients who are seen in the clinic, Qin concludes.

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Angel Qin, MD, discusses treatment considerations for immunotherapy in patients with newly diagnosed non–small cell lung cancer.

Dr. Qin on Treatment Considerations for Immunotherapy in NSCLC

Angel Qin, MD, clinical assistant professor, University of Michigan Health, medical oncologist, Rogel Cancer Center, Michigan Medicine, discusses selecting between single-agent immunotherapy or combination chemoimmunotherapy in non–small cell lung cancer (NSCLC).

The PD-L1 expression level of a patient with NSCLC largely determines whether the patient should receive single-agent immunotherapy or combination chemoimmunotherapy, Qin explains. For example, patients with PD-L1 expression at least 50% can be considered for single-agent immunotherapy. However, if the patient has significant tumor burden or is on the verge of visceral crisis from disease burden, chemotherapy may be added to immunotherapy for cytotoxic reduction, Qin says. In these situations, the full course of chemotherapy may not be required, Qin adds. 

For patients with PD-L1 expression between 1% and 49%, performance status guides treatment decisions, Qin says. Although single-agent pembrolizumab (Keytruda) is approved for use in this patient population, patients may not derive a sufficient response without chemotherapy. However, altering the treatment regimen to introduce histology-specific chemotherapy later after platinum-based chemotherapy and pembrolizumab may be beneficial for patients. 

Additionally, some patients have strong aversions to chemotherapy, so single-agent pembrolizumab can be considered based on patient preference as well, Qin concludes.

Angel Qin, MD, discusses selecting between single-agent immunotherapy or combination chemoimmunotherapy in non–small cell lung cancer. 



Angel Qin, MD

Articles

Dr. Qin on Treatment Considerations for Immunotherapy in NSCLC

Dr. Qin on Selecting Single-Agent Immunotherapy or Chemoimmunotherapy in NSCLC